Otolaryngology Coding Alert

Question: Our otolaryngologist performed a styloidectomy on a patient suffering from Eagle Syndrome. What’s the CPT^® code to report this procedure?

Oregon Subscriber

Answer: Patients suffering from Eagle Syndrome have a notably elongated styloid process or a calcified stylohyoid ligament. This manifests as a pain in the throat, neck, and sometimes ear. A transcervical styloidectomy is the most common means of treating Eagle Syndrome. This procedure involves the surgeon removing the elongated portion of the styloid process.

Unfortunately, as of 2021, the CPT^® book does not have a working code that you will report for styloidectomy procedures. Instead, your only option is the report unlisted code 21499 (Unlisted musculoskeletal procedure, head) and find the most practical comparison code for your paper claim submission.

There isn’t exactly a general consensus among the coding community on the most appropriate comparison code, but some practices prefer to report 21025 (Excision of bone (eg, for osteomyelitis or bone abscess); mandible), whereas others report 21685 (Hyoid myotomy and suspension). What’s most important to consider when reporting either of these two codes is approximating the percentage of work included in these two existing codes as compared to the styloidectomy. This should primarily be left up to the discretion of the surgeon, at which point you will include a note in Box 19 of the CMS-1500 form indicating that the work performed by the surgeon equates to X percentage of code 21025 or 21685.